Sawayama Yuichi, Sasaki Kenta, Taninobu Narumi, Ikuta Akihiro, Osakada Kohei, Kubo Shunsuke, Tada Takeshi, Fuku Yasushi, Tanaka Hiroyuki, Nakagawa Yoshihisa, Kadota Kazushige
Department of Cardiovascular Medicine, Kurashiki Central Hospital, Kurashiki, Japan.
Department of Cardiovascular Medicine, Shiga University of Medical Science, Otsu, Japan.
JACC Asia. 2024 Nov 12;5(1):46-55. doi: 10.1016/j.jacasi.2024.09.004. eCollection 2025 Jan.
Intravascular imaging (IVI) complements coronary angiography and may help prevent coronary artery perforation (CAP) during percutaneous coronary intervention (PCI).
The authors evaluated whether IVI-guided PCI is associated with a lower risk of PCI-related CAP in a real-world cohort.
This observational study analyzed consecutive PCI procedures from January 2006 to October 2023. The procedures were divided into 4 groups according to the year performed: 2006 to 2010 (P1), 2011 to 2015 (P2), 2016 to 2020 (P3), and 2021 to 2023 (P4). We evaluated the trend of IVI-guided PCI and the incidence of CAP. A mixed effects logistic model was employed to assess their relationship.
CAP occurred in 368 (1.6%) of 22,368 PCIs. IVI-guided PCI accounted for 63% of all cases, of which 95% were intravascular ultrasound procedures. From P1 to P3, the ratio of IVI-guided PCI increased linearly (P1: 30%, P2: 61%, P3: 93%, P4: 97%), while the incidence of CAP decreased (P1: 2.10%, P2: 1.74%, P3: 1.13%, P4: 1.18%). IVI-guided PCI showed a significant association with a lower risk of the overall incidence of CAP (adjusted OR: 0.78; 95% CI: 0.61-0.99; 0.047). This relationship was particularly significant for chronic total occlusion PCI (adjusted OR: 0.59; 95% CI: 0.43-0.80; 0.001) and PCI for moderate or severe calcification (adjusted OR: 0.50; 95% CI: 0.33-0.74; 0.001).
IVI-guided PCI may help prevent PCI-related CAP, especially in the setting of chronic total occlusion PCI and PCI for moderate or severe calcification.
血管内成像（IVI）是冠状动脉造影的补充手段，可能有助于预防经皮冠状动脉介入治疗（PCI）期间的冠状动脉穿孔（CAP）。
作者评估了在真实世界队列中，IVI引导的PCI是否与PCI相关CAP的较低风险相关。
这项观察性研究分析了2006年1月至2023年10月期间连续进行的PCI手术。根据手术年份将这些手术分为4组：2006年至2010年（P1）、2011年至2015年（P2）、2016年至2020年（P3）和2021年至2023年（P4）。我们评估了IVI引导的PCI的趋势以及CAP的发生率。采用混合效应逻辑模型评估它们之间的关系。
22368例PCI中有368例（1.6%）发生了CAP。IVI引导的PCI占所有病例的63%，其中95%为血管内超声检查。从P1到P3，IVI引导的PCI比例呈线性增加（P1：30%，P2：61%，P3：93%，P4：97%），而CAP的发生率下降（P1：2.10%，P2：1.74%，P3：1.13%，P4：1.18%）。IVI引导的PCI与CAP总体发生率的较低风险显著相关（调整后的OR：0.78；95%CI：0.61 - 0.99；P = 0.047）。这种关系在慢性完全闭塞PCI（调整后的OR：0.59；95%CI：0.43 - 0.80；P = 0.001）和中度或重度钙化的PCI（调整后的OR：0.50；95%CI：0.33 - 0.74；P = 0.001）中尤为显著。
IVI引导的PCI可能有助于预防PCI相关的CAP，尤其是在慢性完全闭塞PCI和中度或重度钙化的PCI中。
